The FEHBlog noticed this Tammy Flanagan article about an unscientific but interesting FEHBP experiment which is an appropriate link for the last day of Open Season. The FEHBP remains competitive.

The Federal Benefits Open Season ends tomorrow. Also coming down to the wire is Congressional action on federal appropriations and tax extenders (as well as financial assistance for first responders to the September 11, 2001, tragedy).  Fox News offers a comprehensive overview of the upcoming busy week on Capitol Hill while the Week in Congress reviews the last week’s actions.  The FEHBlog will be keeping an eye out for the possible two year extension of the effective date for the 40% excise tax on high cost employer sponsored health benefits coverage (from 2018 to 2020).  Fox explains that the House version of the must pass bills will be posted tomorrow.

The FEHBlog noticed that the OPM Inspector General has posted his semi annual report to Congress for the period ended September 30, 2015 together with the agency’s management response. Always interesting reading.

In other OPM news, Kaiser Health News reports on the status of the multi-state program that OPM operates in the ACA healthcare exchanges and Federal News Radio reports that

A former federal counterintelligence official [Doug Thomas] says the White House is poised to stand up a new agency that will own the federal security clearance process. The formation of a new organization, the National Investigative Service Agency, would move ownership of the security clearance process away from the Office of Personnel Management, which assumed oversight of the program from the Defense Department in 2004.

Drug Channels provides five prescription drug benefit takeaways from the recently issued CMS report on U.S. healthcare spending for 2014.  The fifth takeaway surprised the FEHBlog because it contrasts with the report’s general view that prescription drug costs are rising sharply:

In 2014, consumers’ out-of-pocket expenses—cash-pay prescriptions plus copayments and coinsurance—grew by $1.2 billion, from $43.5 billion in 2013 to $44.7 billion in 2014. However, consumers’ share of outpatient prescription drug expenditures expenses shrank, from 16.4% in 2013 to a historically low 15.0% in 2014. The consumer’s share is predicted to keep dropping, as [Drug Channels] explain[s] in Here’s Who Will Pay For Prescription Drugs in 2024.

Congress has extended the continuing resolution funding the federal government through next Wednesday December 16 according to the AP. The Wall Street Journal reports that Congress continues to consider a two year delay (from 2018 to 2020) in implementing the 40% excise tax on high cost employer sponsored coverage as part of these appropriations and tax extender negotiations. A United Benefit Advisors survey projects that 74% of employers will be impacted by this excise tax by 2022.  

CMS has announced that more quality data has been added to the Hospital Compare and Physician Compare websites.

Reuters reports on a Senate Special Committee on Aging hearing on drug price gouging held earlier this week.

The Federal Benefits Open Season’s last day is this coming Monday December 14.

Congressional leadership continues to make progress on the must pass omnibus appropriations and tax extenders bills according to the Hill.  Congress is likely to enact a brief extension of the current continuing resolution funding the federal government, which expires on Friday, in order to wrap up its work next week.  Happily, the Hill reports that “Senate negotiators are ready to sign off on a major tax deal that would include a two-year moratorium on two unpopular ObamaCare taxes, the Cadillac tax on expensive plans and the medical device tax.” That outcome would push back the Cadillac tax effective date from 2018 until 2020.

It’s a misnomer to say that it’s a tax on expensive plans because all robust health plans are expensive.  The Cadillac tax is a screwy Affordable Care Act provision that will impose significant burdens on insurers and employers.  No word on the tax extended initiative to repeal the health insurer tax, which only serves to push premiums closer to the Cadillac tax thresholds.

PriceWaterhouseCoopers issued a report today on the top health industry trends for 2016. One of those trends is increase attention on prescription drug pricing. The Wall Street Journal published an intriguing report today on how Pfizer priced a new cancer drug.

The Hill reports that as part of a must pass tax extenders bill, Congress is giving serious consideration to delaying for two years (until 2020) the 40% excise tax on high cost employer sponsored health benefits coverage and repeal of the onerous health insurer tax in 2018.  The AP reports on continuing negotiations over the FY 2016 omnibus appropriations bill to fund the federal government past December 11.  A partial government shutdown remains unlikely.  The FEHBlog will keep tracking these developments over the course of this week.

The Week in Congress discusses last week’s activities on Capitol Hill which included Senate passage of a bill to substantially repeal the Affordable Care Act.  This will be the first time that an ACA repeal bill actually reaches the President’s desk (for a veto).  The intriguing angle is the Hill report that as part of this process the Senate voted 90-10 to approve an amendment to this bill that would repeal the 40% excise tax on high cost employer sponsored health coverage.

Yesterday, the Centers for Medicare and Medicaid Services released their report on U.S. healthcare expenditures in 2014. Cost curve up.

Stars and Stripes reports on a Congressional hearing about TRICARE which provides health benefits to military family members and retirees. The report caught the FEHBlog’s eye because a blue ribbon panel had recommended replacing TRICARE with a program similar to the FEHBP.  The article indicates that Congress is more likely to seek to fix and not scrap TRICARE. Attention appears to be focusing on “a blended system that would direct more [TRICARE] beneficiaries to base hospitals, rely more on clinics in places with smaller military populations, and offer guard and reserve troops insurance plans like ones offered to federal workers.

Healthcare Data Management reports on findings stemming from a mock cyberattack involving twelve insurers conducted this past summer.

Identification and response gaps by the health plans during the attacks were revealing. Some of the plans, Gelinne said, did not even know who had authority to order taking down the claims processing system during the attack. That’s one reason it is important to establish formal integrated cyber response plans across the organization, he added. “It truly is a team sport.”
Other findings included: 

* As the attack unfolded, HITRUST shared intelligence with the plans, but participants—who were to share information such as threat indicators among themselves and with HITRUST—were reluctant to do so. That aligns with a recent HITRUST survey that found 85 percent of organizations use their own threat indicators but only five percent share the data.

* Participants were uncertain about how to quantify losses and submit insurance claims, and what to expect after reporting an attack. “Each insurer is likely to have distinct processes,” according to information from HITRUST. “Incident response plans should include information on how to engage insurers.”

* Only two of the 12 health plans referenced their organization’s incident response plan while responding to the attack. “While the pace of a live situation may make strict adherence to documented plans impractical, having ready access to key information and adhering to roles and responsibilities defined in the plan can improve efficiency,” according to HITRUST.

* Organizations need to bring in law enforcement at the appropriate time; several health plans engaged police before evidence of a crime had been established. “Law enforcement can aid in compiling and preserving evidence, but acting too soon may distract efforts from aspects of the investigation and recovery process,” HITRUST cautioned.

A valuable drill.

Today the OPM Director  Beth Cobert commented in her blog on the progress that OPM is making in notifying people affected by the agency’s data breach.  She also announced that OPM has created

a verification center [website] to help individuals who have had their information stolen in the malicious cyber intrusion carried out against the Federal Government. This verification center will help those who believe their data may have been taken but have not received a notification letter from the government. The center will also assist individuals who have received a letter letting them know they were impacted by the background investigation records intrusion, but who have lost the PIN code that allows them to sign up for the free services that the Federal Government is providing.

The Wall Street Journal reported today on why the U.S. pays higher prices for prescription drugs than other industrialized countries.  The short answer is that other industrialized countries rely on government price controls.

The pharmaceutical industry says controls such as those seen in Europe discourage investment in research and deny patients access to some drugs. “The U.S. has a competitive biopharmaceutical marketplace that works to control costs while encouraging the development of new treatments and cures,” said Lori Reilly, an executive at the Pharmaceutical Research and Manufacturers of America, a trade association. If U.S. pricing fell to European levels, the industry would almost certainly cut its R&D spending, said Mr. Evans, the health-care analyst. “Does the U.S. subsidize global research? Absolutely, yes,” he said. 

Surely there must be a happy medium.

On the bright side, the Journal also reported on successful, entreprenurial initiatives by health care providers to better educate patients about their health care conditions and hospital discharge plans.

Research shows patients don’t absorb much of the medical information they receive from their physician and are often wrong about what they do remember. Patients “immediately” forget 40% to 80% of what the doctor told them, according to a 2003 paper in Britain’s Journal of the Royal Society of Medicine.
Some 50% of patients discharged from hospitals make mistakes in their aftercare with medications, and many end up back in the hospital, says Brian Jack, chief of family medicine at Boston Medical Center, who is leading a research effort he hopes will retool the discharge process in U.S. hospitals. “We throw papers and throw words at patients. It is crazy to think they would understand,” he says. This is especially true of older patients and those who are depressed.

The new approaches rely on video and audio recordings that can be replayed along with provider follow-up.

The FEHBlog trusts that his readers enjoyed the Thanksgiving holiday. The House of Representatives and the Senate resume attending to the people’s business tomorrow with twelve days left before the continuing resolution funding the federal government expires on December 11.  The Hill reports on the key measures pending before Congress this month.

The Federal Benefits Open Season has two weeks left before its conclusion on December 14. Tammy Flanagan provides advice on items for federal and postal employees to consider before then.

Health Data Management makes five cybersecurity predictions for 2016 (none encouraging) while OPM introduces the public to Clifton Triplett, the new senior cybersecurity advisor to the agency’s director.

The Wall Street Journal reports on how the collapse of New York State’s health care co-op, Health Republic Insurance, is costing the State’s medical practices millions of dollars in unpaid claims. The irony is that there was no reason for Congress to create these new co-ops in the ACA because there are plenty of non-profit insurers. In any event, the ACA is aimed at limiting the net income of for profit and non-profit insurers.

Federal News Radio reports that OPM is experiencing a busy Federal Benefits Open Season due to the availability of the new self plus one enrollment type. “Typically within the first two weeks of Open Season, the volume of changes processed is between 90,000 to 130,000. This year, OPM officials said, from the start of Open Season on Nov. 9 through Nov. 20, more than 270,000 enrollment transactions have been processed.” OPM has estimated that 1 million enrollees are in a position to select the self plus one enrollment type (roughly 50% of the current self plus family enrollees).  The article also explains how enrollees can switch to self plus one if they miss this Open Season opportunity which ends on December 14.

Here’s OPM’s advice on how to make enrollment changes this Open Season:

Annuitants with access to a computer should visit https://retireefehb.opm.gov/Annuitant/ Due to the high number of calls to Open Season Express, OPM strongly encourages use of the on-line enrollment system. Annuitants who do not have access to a computer can call Open Season Express at 1-800-332-9798. The Open Season Express phone line is a dedicated line for FEHB Open Season actions only. 

Employees should visit OPM’s Open Season website www.opm.gov/healthcare-insurance/open-season/ for information. Open Season Express is not for employees. They will be directed to contact their agency for assistance.

In an interesting development, a bipartisan group of Senators and Representatives has asked the White House for a meeting on creating a path to repealing the excise tax on high cost employer sponsored coverage.

The Centers for Medicare and Medicaid Services have reported on the state of ICD-10 coding implementation in the Medicare and Medicaid programs according to this EHR Intelligence article.

Last week, the Department of Health and Human Services held a pharmeutical forum. MedScape reports on the conference here. The article opens as follows:

The increasing number of patients using specialty drugs has helped to drive a 12% increase in the nation’s overall pharmaceutical spending so far in 2015, according to an analysis presented at a US Department of Health and Human Services (HHS) conference Friday [November 20].

The Wall Street Journal reports today on a study finding that surprising price increases are also affecting dermatologist drugs — whether or not they are specialty drugs.

Retail prices of 19 brand-name prescription drugs for dermatologic conditions ranging from acne to cancer increased fivefold on average between 2009 and 2015, according to a study that adds new fuel to the burgeoning debate over the cost of medicines.

The Medscape article concludes with the following official observations from the HHS Forum:

Both [HHS Secretary Sylvia] Burwell and [CMS Acting Administrator Andy] Slavitt said that the government was trying to balance the need for new therapies — and companies’ ability to innovate and compete — with patients’ access to affordable products. Slavitt said that the feds wanted more transparency on how prices were set, and would seek more effectiveness data, also. “We must increase the transparency of the information available about drug pricing and value,” he said. And the government is also looking at creating incentives for drug makers to prove value — such as rewards for keeping patients out of hospitals, he said. “How do we think in terms of episodes of effective treatment, rather than just the cost of a pill?” said Slavitt.

Fair question.